Oh no, it can certainly be a true compliment, as in "I just made these cookies, Miss Sallie, and thought you might like some." "Well, bless your heart, aren't you nice." (If the gift-giver is a child or a young woman, it could be "aren't you precious.") Or it can be an expression of sympathy, as in "My arthritis is acting up again." "Awwww, bless your heart."
That may be the case in some places but, I assure you, it's not within my circles!
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